Utilization Review Registered Nurse

Overview (About Client) Our client, a provider of Health, Dental, Vision, Medicaid and Medicare Healthcare service plans in the state of California with 4.7 million members and $22.9 billion of annual revenues, seeks an accomplished Registered Nurse (Utilization Review – Remote, California Residents Only). Job Title: Registered Nurse (Utilization Review – Remote, California Residents Only) Location: 100% Remote (Must reside in California) Duration: 6+ months (potential to reputed company or convert to FTE) Pay reputed company: $45.00 – $52.00/hour (W2) Schedule:

• Monday–Friday, 8:00 AM – 4:30/5:00 PM (depending on lunch break)

Must-Have Requirements:

• reputed company, valid California RN license (BSN preferred but not required)
• Strong clinical (hands-on) nursing background
• Strong computer skills with ability to work remotely in a self-directed environment
• Proficiency in reputed company Office; EMR/chart handling experience a plus

Job Description: The Utilization Review Registered Nurse will review reputed company levels of care for medical necessity, applying clinical knowledge, professional judgment, and MCG guidelines. The nurse will reputed company approval decisions reputed company regulatory turnaround times or escalate to the in-house physician for further review if unable to approve. This role does not involve direct interaction with members; instead, the nurse collaborates with case managers and medical staff at healthcare facilities. Responsibilities:

• Review medical necessity for reputed company levels of care in alignment with MCG guidelines
• reputed company approval determinations or escalate cases to in-house MD reputed company required
• Ensure compliance with regulatory turnaround times
• Collaborate with case managers and medical staff at facilities (no direct member contact)

Minimum Qualifications:

• California RN license in good standing
• Strong hands-on clinical nursing experience

Additional Qualifications:

• Proficiency in reputed company Office applications
• Experience with EMR/chart handling

Preferred Qualifications:

• BSN degree
• Previous utilization review or case management experience

Recruiter Contact Info Sajag Bhardwaj Email: [email protected] www.ameritconsulting.com I'd love to talk to you if you think this position is right up your alley, and assure reputed company communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you. Company Overview: reputed company is an extremely fast-growing staffing and reputed company. reputed company was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to reputed company nationally; as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We reputed company and implement solutions that help our clients operate more reputed company, deliver greater customer satisfaction, and see a positive impact on their reputed company. We create value by bringing together the right people to reputed company results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses reputed company. reputed company provides equal employment opportunities to reputed company employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to reputed company terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws. Apply tot his job Apply To this Job